Postmenopausal women who smoked are more likely to lose teeth due to periodontal disease

“Regardless of having better oral health practices, such as brushing and flossing, and visiting the dentist more frequently, postmenopausal women in general tend to experience more tooth loss than men of the same age.”

Xiaodan Mai, PhD candidate, Department of Social and Preventive Medicine

BUFFALO, N.Y. – Postmenopausal women who have smoked are
at much higher risk of losing their teeth than women who never
smoked, according to a new study published and featured on the
cover of the Journal of the American Dental Association by
researchers at the University at Buffalo.

The study involved 1,106 women who participated in the Buffalo
OsteoPerio Study, an offshoot of the Women’s Health
Initiative, (WHI), the largest clinical trial and observational
study ever undertaken in the U.S., involving more than 162,000
women across the nation, including nearly 4,000 in Buffalo.

The UB study is the first to examine comprehensive smoking
histories for participants that allowed the researchers to unravel
some of the causes behind tooth loss in postmenopausal women who
smoked.

The study, which appears in the journal’s current issue is
available at http://jada.ada.org/content/144/3/252.full.

Smoking has long been associated with tooth loss, but
postmenopausal women, in particular, experience more tooth loss
than their male counterparts.

“Regardless of having better oral health practices, such
as brushing and flossing, and visiting the dentist more frequently,
postmenopausal women in general tend to experience more tooth loss
than men of the same age,” says Xiaodan (pronounced
Shee-ao-dan) Mai, a doctoral student in epidemiology in the UB
Department of Social and Preventive Medicine in the School of
Public Health and Health Professions. “We were interested in
smoking as a variable that might be important.”

While fewer adults lose their teeth now than in past decades,
tooth loss is associated with poor health outcomes, including
stroke, cancer, rheumatoid arthritis and diabetes.

In the UB study, heavy smokers -- defined as those who had at
least 26 pack-years of smoking, or the equivalent of having smoked
a pack a day for 26 years -- were nearly twice as likely to report
having experienced tooth loss overall and more than six times as
likely to have experienced tooth loss due to periodontal disease,
compared to those who never smoked.

Participants provided information to researchers using a
detailed questionnaire covering smoking history. Each participant
also underwent a comprehensive oral examination and reported to the
dental examiners reasons for each tooth lost. In some cases, the
patient’s dental records also were reviewed.

“We found that heavy smokers had significantly higher odds
of experiencing tooth loss due to periodontal disease than those
who never smoked,” explains Mai. “We also found that
the more women smoked, the more likely they experienced tooth loss
as a result of periodontal disease.”

On the other hand, they found that smoking was a less important
factor in tooth loss due to caries. That’s an important
distinction, says Mai.

“Periodontal disease is a chronic, inflammatory condition
that may be related to the development of cancer,” she
explains.

The paper notes that cigarette smoke may accelerate periodontal
disease and that other studies suggest that chemicals found in
smoke may favor plaque-forming bacteria that could reduce the
ability of saliva to be antioxidative. Nicotine also has been
shown to reduce bone density and bone mineral factors while
estrogen hormones have been found to be lower among women who
smoke.

Mai is now interested in pursuing research that could determine
whether smokers with periodontal disease are at even greater risk
for certain cancers than smokers without periodontal disease.

“Tooth loss due to periodontal disease is a prevalent
condition among postmenopausal women that severely impacts their
dietary intake, aesthetics, and overall quality of life,”
says Mai. “Women now have yet another, very tangible reason
for quitting smoking.”

Co-authors with Mai are: Jean Wactawaski-Wende, PhD, principal
investigator on the WHI, professor and associate chair of the UB
Department of Social and Preventive Medicine, professor of
gynecology-obstetrics, and UB's vice provost for strategic
initiatives; Kathleen M. Hovey, data analyst, Michael J. LaMonte,
PhD, assistant professor and Chaoru Chen, PhD, formerly a
postdoctoral scholar, all in the UB Department of Social and
Preventive Medicine. Mine Tezal, DDS, PhD, assistant professor and
Robert J. Genco, DDS, PhD, Distinguished Professor of Oral Biology
and Microbiology in the Department of Oral Biology, both in the UB
School of Dental Medicine also are co-authors.

The research was funded by the National Institute of Dental and
Craniofacial Research and the National Heart Lung and Blood
Institute, both of the National Institutes of Health, and the US
Army Medical Research and Materiel Command.